Using the missed opportunity tool as an application of the Lives Saved Tool (LiST) for intervention prioritization

Yvonne Tam,Luwei Pearson

doi:10.1186/s12889-017-4736-3

Yvonne Tam, Luwei Pearson

Open Access

https://doi.org/10.1186/s12889-017-4736-3

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Abstract

BackgroundThe Missed Opportunity tool was developed as an application in the Lives Saved Tool (LiST) to allow users to quickly compare the relative impact of interventions. Global Financing Facility (GFF) investment cases have been identified as a potential application of the Missed Opportunity analyses in Democratic Republic of the Congo (DRC), Ethiopia, Kenya, and Tanzania, to use ‘lives saved’ as a normative factor to set priorities.MethodsThe Missed Opportunity analysis draws on data and methods in LiST to project maternal, stillbirth, and child deaths averted based on changes in interventions’ coverage. Coverage of each individual intervention in LiST was automated to be scaled up from current coverage to 90% in the next year, to simulate a scenario where almost every mother and child receive proven interventions that they need. The main outcome of the Missed Opportunity analysis is deaths averted due to each intervention.ResultsWhen reducing unmet need for contraception is included in the analysis, it ranks as the top missed opportunity across the four countries. When it is not included in the analysis, top interventions with the most total deaths averted are hospital-based interventions such as labor and delivery management in the CEmOC and BEmOC level, and full treatment and supportive care for premature babies, and for sepsis/pneumonia.ConclusionsThe Missed Opportunity tool can be used to provide a quick, first look at missed opportunities in a country or geographic region, and help identify interventions for prioritization. While it is a useful advocate for evidence-based priority setting, decision makers need to consider other factors that influence decision making, and also discuss how to implement, deliver, and sustain programs to achieve high coverage.

Highlights

The Missed Opportunity tool was developed as an application in the Lives Saved Tool (LiST) to allow users to quickly compare the relative impact of interventions
Missed opportunities for women, stillbirths, children less than 1 month of age, and children 1–59 months of age are shown by intervention in Figs. 1, 2, 3, and 4 for Democratic Republic of the Congo, Ethiopia, Kenya, and Tanzania
The proportion of deliveries attended by skilled attendants at facilities are typically low in these countries, while receiving high quality care from a skilled attendant during labor and delivery at a Comprehensive Emergency Obstetric Care (CEmOC) level facility is highly effective at averting deaths [11,12,13]

Summary

Introduction

The Missed Opportunity tool was developed as an application in the Lives Saved Tool (LiST) to allow users to quickly compare the relative impact of interventions. There are various priority setting tools available to guide decision makers to assess potential mortality impact and cost effectiveness of health programs. The Lives Saved Tool is one among them that goes beyond considering potential impact and cost effectiveness of health interventions, and account for context-specific effectiveness of interventions, has the ability to conduct prioritization in national and subnational levels, and the Missed Opportunity tool as a ‘first look’ at prioritizing interventions according to their impact There have been published experiences of using LiST to guide decisions in country-level program planning in countries such as Burkina Faso, Ghana, Malawi, Ethiopia, and South Africa [4,5,6]. If there is no universal access to these interventions, the potential deaths averted will become “missed opportunities”.

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